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Commonwealth puts the boot in, again

Veteran THCB readers shouldn’t need too much reminding about this, so I’ll spare you the blow by blow documented here over the years. Here’s the bottom line. Any time you do a trans-national study on health care, you find that the U.S. spends way too much and gets way too little in terms of quality and outcomes.

In doing these studies the Commonwealth Fund has become the bete noir of the political right.

Why? Well it starts with data first and then draws conclusions, rather than the opposite approach followed by most on the right. And whatever way you look at the data they’ve produced over the years, it’s clear that things aren’t going well.

This year is the second annual national scorecard on delivering health care to reduce the number of preventable deaths. Commonwealth calls this its study of high performing health care systems. Yup, we haven’t got one.

From the NY Times write up two things are apparent. First, it’s hard to do national campaigns where we have no national system and no realistic way of national enforcement. Second, as we start with a huge group of uninsured and even more people who are only marginally in the system with significant and untreated health problems, we’re always playing catch up. Everyone else is doing better, and we’re staying where we are.

By the way, Harris Interactive which has been involved in lots of the Commonwealth work, got some press earlier this week by showing that Americans rated their health care system much worse and in greater need of serious reform than did citizens from ten other countries.

Of course, my "favorite lobbyist" can explain the extra costs of insurance administration here versus elsewhere. Really!

Karen Ignagni, the chief executive of America’s Health Insurance Plans, an industry trade group, argues that much of the higher administrative costs stem from the additional services provided by United States insurers, like disease management programs, and the burdensome regulatory and compliance costs of doing business in 50 states.

That’s right, disease management programs are adopted by insurers because they increase health care costs!It’s hard to know what to say in response, other than to suggest that this wasn’t how it was meant to be.

Meanwhile, although the NY Times says no one will defend the current system (hence only finding Ignagni to deliver half a quote) plenty of people continue to get rich off it. So changing it remains very very difficult. As Brian Klepper excellently points out elsewhere on THCB today.

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markScott HodsonMichael MillensonMaggie MaharJames Recent comment authors
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mark
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mark

James, you criticize everyone else, but make no suggestion about fixing the healthcare mess. Do you think there isn’t a problem with the system now? and how does any of this bickering, get health care to the people who can’t get healthcare of any kind at an affordable price. Healthcare that puts human like over the profit motive is what we need. That is what we have now, do you think that is the appropriate approach to Healthcare.
We need to try something, just because there will be transition problems, is no reason not to try.

mark
Guest
mark

James, you criticize everyone else, but make no suggestion about fixing the healthcare mess. Do you think there isn’t a problem with the system now? and how does any of this bickering, get health care to the people who can’t get healthcare of any kind at an affordable price. Healthcare that puts human like over the profit motive is what we need. That is what we have now, do you think that is the appropriate approach to Healthcare.
We need to try something, just because there will be transition problems, is no reason not to try.

Scott Hodson
Guest

Many American health systems are significantly underinvested in quality management Infrastructure, Process, and Organization. In order to achieve breakthrough improvements in quality, patient safety and resource utilization, hospitals and health systems need a “world class” quality management foundation that includes: Strategy: including a clear linkage of quality and patient safety to the organizational strategy and a Board-driven imperative to achieve quality goals. Infrastructure: incorporating effective quality management technology, EMR and physician order entry, evidence based care development tools and methodologies, and quality performance metrics and monitoring technology that enables “real time” information. Process: including concurrent intervention, the ability to identify… Read more »

James
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James

“I am afraid that there is quite a bit of truth to Matthew’s statement: many on the Right start with an idea, then work backwards to get the data.” As someone who has done policy work for more than a few years, I see the Left do it, too. Activists of all stripes start out with a belief. That which fits their belief is considered. That which does not is ignored. Again, beginning a discusion of an issue by insulting the political leanings of the person across the table is not the best way to start a dialog. Advocates often… Read more »

Michael Millenson
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Michael Millenson

Matthew, I think you’re misconstruing Karen’s comment that you quote, although certainly not the overall intent. The U.S. has higher costs because of two things, she is saying. One of them is bad — evil government regulation in the states. The other is good — high-priced health insurance plans, which provide various services (such as disease management, since AHIP is now on the side of wellness) that more than pay for themselves. Clearly, if you just got rid of government regulation that inhibits health plans from reaching their full potential, we’d be able to spend more on health care than… Read more »

Michael Millenson
Guest
Michael Millenson

Matthew, I think you’re misconstruing Karen’s comment that you quote, although certainly not the overall intent. The U.S. has higher costs because of two things, she is saying. One of them is bad — evil government regulation in the states. The other is good — high-priced health insurance plans, which provide various services (such as disease management, since AHIP is now on the side of wellness) that more than pay for themselves. Clearly, if you just got rid of government regulation that inhibits health plans from reaching their full potential, we’d be able to spend more on health care than… Read more »

Maggie Mahar
Guest

James–
I am afraid that there is quite a bit of truth to Matthew’s statement: many on the Right start with an idea, then work backwards to get the data.
See Greg Anrig’s excellent book “The Conservatives Have No Clothes” documenting this point in detail. (Full disclosure: I work with Greg at The Century Foundation.)

James
Guest
James

“In doing these studies the Commonwealth Fund has become the bete noir of the political right.” I am a card-carrying member of the “political right” who has been involved with health care policy for several years. I read and find value in some of the items from the Commonwealth Fund, as I also do from the Heritage Foundation or the national Center for Policy Analysis. I really don’t care where a good idea comes from. On the flip side, both the political left and right advocate truly horrible ideas for health care – sometimes in a bipartison error-fest. Why did… Read more »